Consensus on Perioperative Management of Carcinoid Crisis in Neuroendocrine Tumours

Carcinoid crisis is a critical concern for patients with neuroendocrine tumours undergoing invasive surgical interventions. To standardize and optimize perioperative care, an international multidisciplinary panel comprising 44 experts and 3 patient partners developed consensus-based recommendations for patients with midgut and bronchopulmonary neuroendocrine tumours undergoing non-cardiac surgery.

The panel utilized a modified Delphi process involving four rounds of anonymous voting using a 1-to-7 Likert scale. Consensus was defined with a median score between 5 and 7, and 13 or fewer panellists rating outside the score category containing the median.

Final consensus was reached on 41 statements, comprising 12 on preoperative work-up and optimization, 27 on intraoperative management (including monitoring, prophylaxis, and treatment of crisis), and 2 on postoperative management. The panel's principal practice-shifting recommendations state that somatostatin analogues are not necessary for prophylaxis before surgery or on the day of operation, and that treatment during an active carcinoid crisis should start with vasopressors, with short-acting somatostatin analogues used as an adjunct.